MORE than 155,000 people are at risk of losing their full medical cards amid warnings that 2014 could be the toughest year yet for the health service.

Under the measures announced in the Budget, the income thresholds for the over-70s will see 35,000 become ineligible for a medical card and downgraded to a GP-visit card in a bid to save €25m.

Another 22,000 people, who were unemployed and were promised they could hold on to their medical card for three years after they got a job, are also to be reduced to GP-visit card as part of an €11m crackdown.

Medical card holders get their doctors' fees and medicines free, but under the GP visit card they are liable to pay up to €144 a month for drugs.

The Health Service Executive (HSE) has also been ordered to shave €113m from its medical card spending next year by pursuing people who are no long eligible for reasons such as employment, emigration or death.

Health Minister James Reilly was unable to say how many this "probity" measure would remove, but Fianna Fail has estimated that it could see 100,000 lose their medical cards on the basis that each card costs an average of €1,000.

The Department of Health said this was a crude figure as the cut would also take into account inaccurate bills from GPs and pharmacists.

However, the move is expected to result in the HSE intensifying cross-checks, which it is now legally able to do with the Department of Social Protection and the Revenue Commissioners, to find out more about people's income.

The over-70s will be hit by the decision to reduce the income threshold for a single person at that age to €500 a week and to €900 for a couple.

Those whose medical card is removed will still have free GP visits, but they will be forced to pay for their medication.

Legislation is needed for this and it is due to come into effect in early 2014.

Asked how the figure was arrived at, Dr Reilly said a PricewaterhouseCoopers study for the department had estimated that up to €200m worth of medical cards could be paid out for people who are no longer eligible.

He admitted it was a "desktop study" with a rider on that it needed further evaluation.

For that reason it was to be part of an inter-departmental examination of projected cuts in the health budget, he added.

People who hold on to their medical card are to be subject to higher prescription charges and the cost per item will rise from €1.50 to €2.50.

The monthly cap for a family or individual will increase from €19.50 to €25, generating an extra €45m for the health service.

Deterring

Although Dr Reilly recently admitted the charge may be deterring some low-income people from securing all their medicines, he said yesterday there was still evidence that card holders were getting unnecessary painkillers and tablets for indigestion.

It is also planned to de-list a number of medicines from the medical card and other drugs schemes and the HSE is to consider which items should no longer be reimbursable in a bid to save €10m.

The real extent of health cuts will not be known until the HSE produces its service plan for 2014, which will reveal how its financial allocation is shared between services.